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Y4 Paeds > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is bronchiolitis ?

A

Inflammation and infection of the bronchioles. This is usually caused by the respiratory syncytial virus.
Very common in winter
Generally affects under 1 year olds

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2
Q

Why does bronchiolitis cause a wheeze in babies but not adults ?

A

As babies airways are so small the slightest inflammation and mucus in the airway has a significant effect on the infants ability to circulate air to the alveoli and back out.

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3
Q

How do babies with bronchiolitis present ?

A

Coryzal symptoms - runny nose
Signs of resp distress
Dyspnoea
Tachypnoea
Poor feeding
Mild fever
Wheeze and crackles

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4
Q

What are the signs of respiratory distress ?

A

Raised RR
Use of accessory muscles - SCM, abdominal and intercostal muscles
Intercostal and subcostal recession
Nasal flaring
Head bobbing
Tracheal tugging
Cyanosis
Abnormal airway noises

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5
Q

What are some abnormal airway noises ?

A

Wheezing - heard on expiration
Grunting - exhaling with the glottis
Stridor - high pitched inspiratory noise ( croup )

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6
Q

What is the typical RSV course ?

A

Bronchiolitis usually starts as an URTI with coryzal symptoms
Symptoms are generally worse on day 3 or 4.
Full recovery within 2 -3 weeks

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7
Q

What are some reasons for admission for babies with bronchiolitis ?

A

Ages under 3 months or any pre-existing condition ( prematurity, downs or CF )
50-75 or less of their normal intake of milk
Clinical dehydration
RR over 70
O2 below 92
Moderate to severe resp distress
Apnoea

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8
Q

What is the management of bronchiolitis ?

A

Ensuring adequate intake - NG tube or IV fluids if needed
Saline nasal drops
Nasal suctioning
Supplementary o2
Ventilatory support

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9
Q

What are some types of ventilatory support ?

A

High flow humidified o2
Continuous positive airway pressure
Intubation and ventilation

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10
Q

What is high flow humidified oxygen ?

A

Tight nasal cannula delivering air and oxygen continuously with some added pressure. It adds positive end expiratory pressure to maintain the airway.

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11
Q

What is CPAP ?

A

This involves using a sealed nasal cannula that performs in a similar way to high flow o2 but at higher and more controlled pressures.

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12
Q

How is ventilation assessed ?

A

Capillary blood gases

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13
Q

What are the signs for poor ventilation on a blood gas ?

A

Rising pCO2
Falling pH

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14
Q

What is given to babies who were ex-premature and hose with congenital heart disease when they have bronchiolitis ?

A

Palivizumab - monoclonal antibody that targets the RSV.

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15
Q

What is viral induced wheeze ?

A

An acute wheezy illness caused by a viral infection. When the small airways encounter a virus they become inflamed restricting small for airflow.

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16
Q

What features indicate viral induced wheeze over asthma ?

A

Presenting before 3 years old
No atopic history
Only occurs during an infection

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17
Q

How does viral induced wheeze present ?

A

SOB
Resp distress
Expiratory wheeze throughout the chest

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18
Q

What is the management of viral induced wheeze ?

A

Supplementary oxygen
Bronchodilators ( salbutamol or Ipratropium )
Steroids - prednisolone or hydrocortisone )
Abx

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19
Q

What is an acute exacerbation of asthma ?

A

Characterised by a rapid deterioration in the symptoms of asthma. This could be triggered by any of the typical asthma triggers such as infection, exercise or cold weather.

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20
Q

How does acute asthma present ?

A

Progressively worsening SOB
Signs of resp distress
Fast RR
Expiratory wheeze on auscultation heard throughout the chest

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21
Q

Why is silent chest an ominous sign ?

A

This is where the airways are so tight it is not possible for the child to move enough air through the airways to creat a wheeze. This is life-threatening

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22
Q

What are the BTS/SIGN guidelines for moderate asthma attack ?

A

Peak flow above 50%
Normal speech

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23
Q

What are the BTS/SIGN guidelines for life threatening asthma attack ?

A

Peak flow is between 33%
Saturations below 92%
Exhaustion and poor respiratory effort
Hypotension
Silent chest
Cyanosis
Altered consciousness

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24
Q

What are the BTS/SIGN guidelines for severe asthma attack ?

A

Peak flow 33-50%
Saturations below 92%
Unable to complete sentences in one breath
Signs of resp distress
HR ( above 140 in 1-5 years old, above 125 in over 5 years old )

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25
Q

What is the stepwise management of acute asthma ?

A

Salbutamol inhalers ( spacer device )
Nebulised salbutamol / Ipratropium bromide
Oral prednisolone
IV hydrocortisone
IV magnesium sulphate
IV salbutamol
IV aminophylline
Call an anaesthetist

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26
Q

When is discharge appropriate in an asthma attack ?

A

Discharge is considered when the child is well on 6 puffs 4 hourly of salbutamol.

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27
Q

What is the presentation of asthma ?

A

Episodic symptoms with intermittent exacerbations
Diurnal variability - worse at night and in the morning
Dry cough with wheeze and SOB
Typical triggers
Atopy - hay fever, eczema and food allergies
Family history
Bilateral widespread wheeze

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28
Q

What is the presentation indicating a diagnosis other than asthma ?

A

Wheeze only related to coughs and colds
Isolated or productive cough
Normal investigations
No response to treatment
Unilateral wheeze - suggesting a focal lesion, inhaled foreign body or infection

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29
Q

What are the typical triggers of asthma ?

A

Dust (house dust mites)
Animals
Cold air
Exercise
Smoke
Food allergens

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30
Q

What are some investigations for asthma ?

A

Spirometry
FeNO
Peak flow

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31
Q

What is the medical therapy for asthma patients under 5 years old ?

A

SABA
Low dose ICS or Leukotriene antagonist

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32
Q

What is the medical therapy for asthma patients aged 5 - 12 years old ?

A

SABA
Add Low dose ICS
Add LABA
Titrate the ICS up
Consider adding oral montelukast or theophylline

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33
Q

What is the medical therapy for asthma patients aged 12 years and over ?

A

SABA
Add low dose ICS
Add LABA
Titrate up the ICS
Consider oral montelukast
Add oral steroids

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34
Q

What is the MDI technique without a spacer ?

A

Remove the cap
Shake the inhaler
Sit or stand up straight
Lift the chin slightly
Fully exhale
Make s tight seal with your lips
Take a steady breath in whilst pressing the canister
Continue breathing for 3-4 seconds
Hold the breath for 10 seconds
Wait 30 seconds before giving a second dose
Rinse the mouth after using steroid inhalers

35
Q

What is the MDI technique with a spacer ?

A

Assemble the spacer
Shake the inhaler
Attach the inhaler to the correct end
Sit or stand up straight
Make a seal around the spacermouthpiece
Spray the dose into the spacer
Take steady breaths in and out 5 times

36
Q

How does someone present with pneumonia ?

A

Cough
High fever
Tachypnoea
Tachycardia
Increased work of breathing
Lethargy
Delirium

37
Q

What are the characteristic chest signs in pneumonia ?

A

Bronchial breath sounds
Focal coarse crackles
Dullness to percussion

38
Q

What are the bacterial causes of pneumonia ?

A

Streptococcus pneumonia
Group A strep
Group B strep
Staph aureus
Hamephilus influenza
Mycoplasma pneumonia

39
Q

What are the viral causes of pneumonia ?

A

RSV
Parainfluenza
Influenza

40
Q

What investigations are performed for pneumonia ?

A

CXR
Sputum cultures
Throat swabs

41
Q

What is the management of pneumonia ?

A

Amoxicillin first line
Adding Macrolide will cover atypical or if penicillin allergy

42
Q

What tests should be performed if a child is having recurrent LRTI’s ?

A

FBC
CXR
Serum immunoglobulins
Test immunoglobulin G
Sweat test for CF
HIV test

43
Q

What is croup ?

A

An acute infective resp disease affecting young children. It typically affects children aged 6 months to 2 years old. It is an URTI causing oedema in the larynx.

44
Q

What is the classic cause of croup ?

A

Parainfluenza

45
Q

How does croup present ?

A

Increased work of breathing
Barking cough
Hoarse voice
Stridor
Low grade fever

46
Q

What is the management for pneumonia ?

A

Most can be managed at home
Oral dexamethasone
O2 if required
If severe - nebulised Budesonide or adrenalin

47
Q

What is epiglottitis ?

A

Inflammation and swelling of the epiglottis caused by infection - typically Haemophilus infleunza type B. The epiglottis can swell and obscure the airway within hours of symptoms developing. It is life threatening

48
Q

What is the presentation suggesting possible epiglottis ?

A

Sore throat
Stridor
Drooling
Tripod position - sat forward with hands on knees
High fever
Difficulty in swallowing
Muffled voice

49
Q

What investigations are performed for epiglottitis ?

A

Lateral x ray of the neck - characteristic thumb sign

50
Q

What is the management of epiglottitis ?

A

Prepare intubation kit just in case
IV abx
Steroids

51
Q

What is a common complication of epiglottitis ?

A

Epiglottis abscess

52
Q

What is laryngomalacia ?

A

A condition affecting infants where the part of the larynx above the vocal cords is structured in a way that allows it to cause partial airway obstruction. This leads to a chronic stridor on inhalation when the larynx flops across the airway.

53
Q

What are the structural changes in laryngomalacia ?

A

The aryepiglottic folds are shortened which pulls on the epiglottis and changes it shape to a characteristic omega shape. The tissue surrounding the supraglottic larynx is softer

54
Q

How does laryngomalacia present ?

A

Peaks at 6 months
Inspiratory stridor intermittent
Difficulty feeding

55
Q

What is the management of laryngomalacia ?

A

The problem resolves as the larynx matures and grows and is better able to support itself, preventing it from flopping over the airway.
Usually no intervention is required.
Rarely a tracheostomy may be necessary

56
Q

What is whooping cough ?

A

An upper respiratory tract infection caused by Bordetella pertussis ( a gram negative bacteria ). The coughing fits can become so severe that the child is unable to take in air between coughs.

57
Q

How does whooping cough present ?

A

Starts with mild coryzal symptoms - low grade fever and mild dry cough
After a week - severe coughing starts - inspiratory whoop

58
Q

How is a diagnosis of whooping cough made ?

A

Nasopharyngeal or nasal swab with PCR testing or bacterial culture

59
Q

What is the management of whooping cough ?

A

Pertussis is a notifiable disease
Supportive care
Macrolide
Prophylactic abx

60
Q

What is a complication of whooping cough ?

A

Bronchiectasis

61
Q

What is chronic lung disease of prematurity ?

A

It occurs in premature babies typically those born before 28 weeks gestation.
These babies suffer with resp distress requiring o2 therapy and intubation

62
Q

What are some features of chronic lung disease of prematurity ?

A

Low o2 sats
Increased work of breathing
Poor feeding and weight gain
Crackles and wheezes on chest auscultation
Increased susceptibility to infection

63
Q

How is chronic lung disease of prematurity prevented ?

A

Giving corticosteroids to mothers that show signs of premature labour
Using CPAP rather than intubation and ventilation
Using caffeine to stimulate the resp effort

64
Q

What is the management of chronic lung disease of prematurity ?

A

A formal sleep study to assess their oxygen saturations during sleep supports the diagnosis.
Palivizumab - given for protection against RSV

65
Q

What is cystic fibrosis ?

A

An autosomal recessive genetic condition affecting the mucus gland. It is caused by a mutation in the CFTR gene on chromosome 7.

66
Q

What are the physiological consequences of CF ?

A

Thick pancreatic and biliary secretions - blockage of the ducts resulting in a lack of digestive enzymes.

Low volume thick airway secretions

Congenital bilateral absence of the vas deferens in males

67
Q

How does the meconium in a CF baby present ?

A

Thick and sticky causing it to get stuck in the bowel
Meconium ileus

68
Q

When is CF diagnosed ?

A

Newborn blood spot test
Recurrent LRTI, failure to thrive or pancreatitis

69
Q

What are some symptoms of CF ?

A

Chronic cough
Thick sputum production
Steatorrhoea
Abdominal pain and bloating
Poor weight and height gain

70
Q

What are some signs of CF ?

A

Low weight or height on growth charts
Nasal polyps
Finger clubbing
Crackles and wheezes
Abdominal distention

71
Q

What are some causes of clubbing in children ?

A

Hereditary clubbing
Cyanotic heart disease
Infective endocarditis
CF
TB
IBD
Liver cirrhosis

72
Q

What investigations should be performed when suspected CF ?

A

Sweat test
Genetic testing

73
Q

What is a sweat test ?

A

Key investigation for cystic fibrosis
Gold standard

A patch of skin is chosen and pilocarpine is applied. Electrodes are placed on either side and a small current is passed between them.
This causes the skin to sweat. The sweat is then absorbed and tested for chloride concentration.

Diagnostic chloride concentration for CF is more than 60mmol/L

74
Q

Why do patients with CF colonise microbes ?

A

Patients with cystic fibrosis struggle to clear the secretions in their airways. This creates a perfect environment with plenty of moisture and oxygen for colonies for bacteria to live and replicate.

75
Q

What are some common colonisers in cystic fibrosis ?

A

Staph aureus
Haemophilus influenza
Klebsiella pneumoniae
E. coli

76
Q

How is pseudomonas colonisation treated in patients with cystic fibrosis ?

A

It can be treated with long term nebulised antibiotics such as Tobramycin.
Oral ciprofloxacin is also used

77
Q

How is cystic fibrosis managed ?

A

Specialist MDT
Chest physiotherapy - to clear mucus and reduce the risk of infection and colonisation
Exercise - improves resp function
High calorie diet
CREON tablets - digest fats in patients with pancreatic insufficiency
Prophylactic flucloxacillin
Bronchodilators

78
Q

What should patients with CF be monitored and screened for ?

A

Diabetes
Osteoporosis
Vitamin D deficiency
Liver failure

79
Q

What is primary ciliary dyskinesia ?

A

Also known as Kartagner’s syndrome
Autosomal recessive affecting the cilia of various cells in the body.
It causes dysfunction of the motile cilia around the body. This leads to a build up of mucus in the lungs.
It can cause chronic chest infections, poor growth and bronchiectasis.
Also affects the fallopian tubes of women and the flagella of the sperm.

80
Q

What is Kartagner’s triad of primary ciliary dyskinesia ?

A

Paranasal sinusitis
Bronchiectasis
Situs inversus

81
Q

What is situs inversus ?

A

A condition where all the internal organs are mirrored inside the body. Therefore the heart is on the right and the liver is on the left.
Dextrocardia is when only the heart is reversed.

82
Q

How is primary ciliary dyskinesia diagnosed ?

A

Recurrent respiratory tract infections
Family history
CXR - situs inversus
Semen analysis - investigate male infertility
Nasal brushing or bronchoscopy ( sample of ciliated epithelium )

83
Q

What is the management of primary ciliary dyskinesia ?

A

Daily physiotherapy
High calorie diet
Antibiotics

Y4 Paeds (14 decks)

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